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Biomedical subjects

N T Mathew

Publications and source records attributed to N T Mathew.

At least 19 recordsLinked to original sources
PubMed1992

Dose ranging efficacy and safety of subcutaneous sumatriptan in the acute treatment of migraine. US Sumatriptan Research Group.

Sumatriptan, a specific serotonin1-like receptor agonist, was studied in the acute treatment of migraine. Two hundred forty-two adult migraineurs participated in a randomized, double-blind study in which one dose of 1, 2, 3, 4, 6, or 8 mg of subcutaneous sumatriptan succinate was evaluated in sequential ascending fashion. At each dose level, a placebo group was included. Efficacy was defined as reduction of moderate or severe pain to mild or no pain, without the use of rescue medication. Headache relief rates showed an approximate dose-response relationship and at 1 hour were as follows: placebo, 24%; 1 mg, 43%; 2 mg, 57%; 3 mg, 57%; 4 mg, 50%; 6 mg, 73%; and 8 mg, 80%. Relief of nausea and improvement in clinical disability were also approximately dose related. Adverse events were dose related; the most common types were injection site reactions and tingling. The 6-mg dose was as effective as the 8-mg dose but was associated with fewer adverse effects and so is optimal.

Adult↗
PubMed1992

Assessment of chronic refractory headache: the role of the MMPI-2.

We investigated the utility of the newly revised version of the Minnesota Multiphasic Personality Inventory, the MMPI-2, for assessing psychopathology in three diagnostic headache groups, Post Traumatic, Status Migrainosus, and Status Migrainosus with Analgesic Rebound. We also investigated whether distinct clusters of headache sufferers could be identified using the MMPI-2 clinical scales, and whether these clusters coincide with headache diagnosis. Eighty-one patients in treatment at the Houston Headache Clinic were diagnosed and administered the MMPI-2. Significant levels of psychopathology were found in all three diagnostic groups. Furthermore, Cluster analysis identified three clusters of patients with equal proportions of patients from the three diagnostic groups. Cluster 1 patients were abnormally high on many MMPI-2 clinical scales; Cluster 2 patients showed more moderate elevations, and Cluster 3 patients had essentially normal profiles. We concluded that the MMPI-2 offers additional information not available through medical diagnosis alone. Thus, it is crucial to include psychological assessment in any comprehensive evaluation of chronic headache patients. Further implications for treatment planning and effectiveness are discussed.

Analysis of Variance↗
PubMed1992

Cluster headache.

In this article we describe the clinical features, natural history, and clinical variants of cluster headaches, following the modern International Headache Society classification of cluster headaches in its two types: episodic and chronic. The basic pathophysiology is considered to be the trigeminal vascular system, the common final pain pathway, with pain initiated in a cyclical fashion by disordered central hypothalamic pacemaker. Oxygen, rapidly acting ergotamine, or dihydroergotamine preparations serve as abortive treatment of acute attacks; various pharmacotherapeutic options and combination therapies aid in the prophylaxis of cluster headache; and trigeminal radio frequency gangliorhizolysis is a very useful surgical approach in patients with chronic cluster headache who are resistant to medical treatment.

Cluster Headache↗
PubMed1991

Valproate in the treatment of persistent chronic daily headache. An open label study.

Thirty patients with persistent chronic daily headache, unresponsive to various combinations of pharmacological and nonpharmacological treatment were selected for an open label study using divalproex sodium. All patients had normal liver function tests. After a baseline observation period of 1 month, patients were given divalproex sodium 1000 to 2000 mg per day, for a period of 3 months. Blood valproic acid levels were kept between 75 and 100 mcg/ml. Liver function studies and blood ammonia levels were obtained periodically. Based on weekly headache index, headache-free days, dysfunctional days and patients' general well-being rating and physicians' global assessment, two thirds of the patients improved significantly. The common side effects included weight gain, tremor, hair loss and nausea. Liver functions were unaffected by treatment. The possible mechanism of action of valproate in headache is discussed. Valproate appears to be a worthwhile addition to the prophylactic treatment of chronic recurrent headache.

Chronic Disease↗
PubMed1990

Drug induced refractory headache--clinical features and management.

Two hundred patients who were taking daily symptomatic or immediate relief medications, often in excessive quantities, yet suffering from daily or near daily severe headaches were studied. One hundred and sixteen (58%) of them were also taking concomitant prophylactic medications and they were ineffective. Low tyramine, low caffeine dietary instructions and biofeedback training were given to all patients. The effect of continuing symptomatic medications, discontinuing symptomatic medications, and adding or changing prophylactic medications were studied in the various treatment groups. It is concluded that; 1.) Daily use of symptomatic or immediate relief medications result in chronic daily headache. 2.) Discontinuing daily symptomatic medications itself result in improvement of headache. 3.) Concomitant use of symptomatic medications nullifies the effect of prophylactic medications. 4.) Discontinuing daily symptomatic medications enhances the beneficial effect of prophylactic medications.

Adolescent↗
PubMed1990

Advances in cluster headache.

The physician may have to combine the art and science of medicine in the management of this most fascinating of human ailments. The choice of drugs and the length of treatment prescribed are greatly influenced by the individual physician's experience, convictions, and reasoning. Needless to say, chronic use of narcotics should be avoided. The author's own regimen is to use combinations of ergotamine prophylaxis with either verapamil or prednisone in episodic cluster headache and with lithium for chronic cluster headache. Management of the treatment-resistant patient remains problematic, but a carefully performed trigeminal radiofrequency thermocoagulation procedure may be worthwhile.

Analgesics↗
PubMed1990

Drug-induced headache.

Headache induced by medications used for nonheadache conditions, and more importantly, headache perpetuated by symptomatic medications used for primary headache disorders are discussed in detail in this article. The clinical features and mechanisms of drug-induced headaches are reviewed. Ergotamine and analgesic rebound phenomena are described. Management strategies for drug-induced headaches are outlined.

Analgesics↗
PubMed1977

Neurotransmitter precursor amino acids in the treatment of multi-infarct dementia and Alzheimer's disease.

Ten patients with severe dementia due to Alzheimer's disease (AD) or multi-infarct dementia (MID) or both, were treated with the precursor amino acids of the neurotransmitters serotonin and dopamine. The precursor amino acids (PAA) were given orally in a preparation that included tyrosine (4 gm daily) and 5-hydroxy-tryptophan (5-HTP) (800 mg daily), plus carbidopa (100 mg daily) as an aromatic amino-acid decarboxylase inhibitor. Diagnosis was established by an electroencephalogram, brain scan, computerized axial tomographic scan, and in one case by necropsy findings. Serial clinical evaluations and measurements of neuropsychologic function were performed. Levels of homovanillic acid (HVA) and 5-hydroxyindole-acetic acid (5-HIAA) were determined before and after administration of probenecid. Side effects of the PAA therapy were diarrhea, drowsiness, nausea, vomiting and agitation, all of which were controlled by reducing the dosage. One patient with MID and one with AD+MID showed clinical and psychologic improvement, but the others did not improve. Analysis of the cerebrospinal fluid for HVA and 5-HIAA before and after the probenecid test indicated some improvement in the metabolic turnover of these acid metabolites of serotonin and dopamine after administration of their precursor amino acids.

5-Hydroxytryptophan↗
PubMed1977

Regional cerebral blood flow statistical patterns and psychological performance in multi-infarct dementia and Alzheimer's disease.

Multivariate data analysis statistical procedures were applied to identify regional cerebral blood flow (rCBF) patterns in patients with multi-infarct dementia (M.I.D.) and Alzheimer's disease (A.D.) when compared to a control group (C.). A fronto-temporal-parietal pattern was identified for the A.D. group. The M.I.D. group demonstrated a predominant temporal parietal pattern. A discriminant function analysis classified 96% of the A.D. and C. patients correctly. One hundred per cent hit rate was obtained in discriminating between M.I.D. and C. Discrimination of A.D. and M.I.D. obtained 82% diagnostic accuracy. When the three groups were compared the hit rate was 93%. Mean rCBF and mean relative weight of the gray matter (Wg) differences were found when each dementia group was compared with C.M.I.D. and A.D. did not differ in mean rCBF but significant differences were found for Wg, with M.I.D. having greater reduction. The performance on standardized psychological tests of two independent samples of A.D. and M.I.D. were compared. The Memory Quotient from the Wechsler Memory Scale was consistently more imparied for the A.D. group. No correlation between degree of psychological impairment and rCBF or Wg reduction was found.

Adult↗